Basic Information
| Provider Information | |||||||||
| NPI: | 1245308493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INA | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 CURRIE HALL PARKWAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 CURRIE HALL PARKWAY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306735812 | ||||||||
| FaxNumber: | 3306737162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1469 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 000000345259 | 01 | ANTHEM | OTHER | 267443000 | 01 | MAGELLAN | OTHER | 2450780 | 05 | OH | MEDICAID | 96870 | 01 | QUAL CHOICE | OTHER |